Will the NHS pay for my treatment abroad?

While many people are not aware it, there are in fact a number of different circumstances in which the NHS will fund a wide range of treatment abroad. This does not mean that you can jet off to Malaysia for your operation, but you can choose treatment anywhere within the European Economic Area, that is European Union member states plus Iceland, Liechtenstein Norway and Switzerland, as long as you meet certain criteria. Download a useful guide to 'A patient's rights to treatment in Europe'.

What treatment will the NHS pay for abroad?

Under the EU Cross Border Healthcare Directive, you have the right to access treatment abroad within the European Economic Area as long as it is medically necessary, and is normally funded by the NHS in your region.

That means that the NHS will not pay for cosmetic surgery or dentistry abroad that is purely for cosmetic reasons, but could cover the cost of other treatments. The judgment as to what is 'medically necessary' is based on the opinion of your local GP or specialist, and not the doctor overseas, and the decision will be checked and verified by your local healthcare commissioner.

How do I get treatment abroad paid for?

There are two routes to access NHS funded treatment abroad. These are the S2 or Social Route and Article 56, also known as the Entitlement Route.

The S2 'social' route – this is a direct agreement between the government and the host nation health service and must be pre-authorised. It only covers treatments and services that are funded by the state in your chosen country, although it can pay more for these services than the equivalent UK costs.

The Article 56 'entitlement' route – this covers healthcare that you pay for yourself, from both state funded and private providers. You do not need always need pre-authorisation, unless you are having a general anaesthetic or require a hospital stay (although it is still a good idea to get it anyway so you know what you will get back). Under this route, you have to pay for your care upfront and claim the money back, although you will only be reimbursed for the equivalent UK treatment costs.

The S2 route means you won't have to pay for your treatment upfront, however the Article 56 route does give you a greater choice, including private practitioners, up to the value of the equivalent treatment at home.

Is this available to everyone?

To qualify for treatment abroad under the NHS, you need to meet certain criteria. For example, you must be a UK resident and eligible for social security services provided by the UK government. You can only choose treatment that you need and only go abroad if the trip will not pose a hazard to your health.

Decisions are made by the healthcare commissioner and your local health board. They have the right to refuse your treatment if it is not necessary or appropriate, and you have the right to appeal if they do. Judgments on what is 'medically necessary' and what is an 'undue delay' are often contentious in these matters.

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